Graves’ Disease and Thyrotoxic Crisis

Graves' Disease and Thyrotoxic Crisis

Graves' disease is an autoimmune disease. The autoantibodies that are produced stimulate the thyroid tissue to produce excessive amounts of thyroid hormones. The changes in organ function are either responses to excess thyroid hormones or responses to the autoantibodies themselves. Graves' disease is almost six times more common in women than men, with onset typically in their 20s and 30s.

Signs and Symptoms include:

Agitation

Emotional changes

Insomnia

Poor heat tolerance

Weight loss

Headache

Tremors

Exophthalmos

Goiter (Enlarged thyroid gland)

Weakness

Dyspnea

Tachycardia

New onset A-fib in the absence of a cardiac history

Nervous system symptoms tend to be more common in young adults, whereas serious cardiovascular symptoms are seen more in older adults.

Cardiac dysfunction from thyrotoxicosis (thyroid storm) is the most likely context in which an emergency call may arise.

Thyrotoxic Crisis - Thyroid Storm

More than 95 percent of cases of thyrotoxicosis are due to Graves' disease.

A thyrotoxic crisis is a life-threatening condition caused by untreated or undertreated hyperthyroidism. In patients with Grave's disease, it can be triggered by trauma or infection.

Signs and symptoms associated reflect the patient's extreme hypermetabolic state and increased activity of the sympathetic nervous system.

High fever (106 degrees F or higher)

Irritability

Delirium or Coma

Tachycardia

Hypotension

Vomiting

Diarrhea

Treatment for these patients is largely focused on supportive care.

Oxygenation (as needed)

Ventilation (as needed)

Fluid resuscitation (as needed)

Cardiac monitoring

Immediate transport

Glucocorticoids and beta blockers may be helpful *always follow your local protocols!